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Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction

Authors Nakajima H, Yoshioka J, Totsuka N, Miyazawa I, Usui T, Urasawa N, Kobayashi T, Mochidome T

Received 25 February 2016

Accepted for publication 24 May 2016

Published 24 August 2016 Volume 2016:11 Pages 1141—1147

DOI https://doi.org/10.2147/CIA.S107136

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker

Hiroyuki Nakajima,1 Jiro Yoshioka,2 Nobuyuki Totsuka,2 Izumi Miyazawa,2 Tatsuya Usui,2 Nobuyuki Urasawa,2 Takahiro Kobayashi,3 Tomoaki Mochidome4

1Department of Cardiology, Nagano Matsushiro General Hospital, 2Department of Cardiology, Nagano Red Cross Hospital, 3Department of Cardiology, Nagano Municipal Hospital, Nagano, 4Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan


Background: Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI.
Design: Single-center, observational, and retrospective cohort study.
Methods: Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL.
Results: The prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively).
Conclusion: Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex.

Keywords: acute myocardial infarction, activities of daily living, disability, Killip classification, primary percutaneous coronary
 intervention

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